For Haiti Orphans, Cross Nursing Can Save Lives: ILCA, UNICEF, WHO, PAHO

For those wondering how on earth aid to a disaster area can exist without huge-scale donations of infanf formula from the United States, or wondering how to explain this to others, this press release from ILCA, and the links therein may extend understanding.

[notes: I prefer the terms “cross-nursing” or “shared breastfeeding”, which don’t so much recall the monetary implications and classist/racist history of “wet-nursing”. Emphases and some links are added by me. You are welcome to reproduce this anywhere, with a backlink.]


– Donate money, not stuff.
– Formula kills in an emergency, even when properly prepared.
– Even in the context of HIV, exclusive breastfeeding (including cross-nursing) is safer than artificial feeding.
– There is not a shortage of breastmilk in Haiti; 99% of young infants were breastfed before the emergency.
– Feed mothers and keep them safe; promote and support expression (when separated) and re-lactation.

Press Release by ILCA, February 1, 2010


A new statement issued jointly by UNICEF, the World Health Organisation, and Pan American Health Organization, reminds relief workers, healthcare professionals, and the public that in an emergency such as the Haiti earthquake, the key to survival of all infants, including orphans, is breastfeeding. When a child is motherless or separated from his or her mother, wet nursing, that is, direct breastfeeding from another lactating mother, is the safest feeding option. Since the breastfeeding rate in Haiti is very high[99% of 0-5 mo are breastfed], there is a good likelihood of being able to find wet nurses for large numbers of motherless infants.

UNICEF, WHO and PAHO have recommended wet nursing, also called “cross nursing” or “shared breastfeeding,” for infants without mothers to “ensure their survival in an emergency situation.” There are a very small number of pathogens that may be transmitted via breastfeeding, including HIV. However, the risk of transmission of HIV via breastfeeding is low. The alternative to wet nursing for motherless infants is use of infant formula. The situation is Haiti is such that formula feeding presents a greater risk than the possibility of HIV infection via wet nursing.

Formula feeding in an emergency is extremely difficult and dangerous. Even when properly prepared, infant formula actively and passively harms the immune system of young babies, placing them at risk of life-threatening diarrhea and respiratory illness. [The Emergency Nutrition Network provides information on how formula can cause deaths due to diarrhea in an emergency.]

Formula feeding also requires extensive investment from the supporting aid agency. This includes a constant supply of infant formula; a stable supply of clean water; a stove and fuel to boil water; a pot, kettle, and feeding cups. Bottles and teats (artificial nipples) should never be used in emergency conditions because they are too difficult to adequately clean. Caregivers also need a clean storage environment, education on minimizing the risks of formula feeding, and medical supervision. This support should be provided not just in the immediate emergency, but until the infant is 12 months old [note Article 6.7 of the International Code of Marketing of Breastmilk Substitutes .

According to the International Lactation Consultant Association (ILCA), wet nursing is not new, and has been practiced since the beginning of time not just in emergencies, but for convenience of mothers. The practice was made more visible with reports of actress Salma Hayek, who breastfed a suffering child in Sierra Leone last year, and Chinese police officer Jiang Xiaojuan, who was reported to have breastfed five additional infants besides her own after the May 2008 earthquake in China.

ILCA provides additional recommendations on supporting breastfeeding mothers consistent with directives from international relief organizations, including:

* Feed the mother so she can, in turn, feed her infant.
* Provide a safe environment for breastfeeding if needed, including providing a private area or a way to breastfeed discreetly, if the mother desires it.
* Assist mothers who are separated from their infants with regular milk removal to avoid engorgement and maintain their milk production for when they are reunited with their baby.
* Assist mothers with re-establishing their milk production if they have already weaned their baby.

ILCA also strongly encourages the general public to avoid the temptation to donate infant formula to Haiti and, instead, to donate funds to relief organizations for use in meeting highest priority needs. Aid agencies supporting infants in Haiti that cannot be breastfed have procured the supplies that they need. Donations of infant formula only complicate the secure and sanitary provision of aid by workers on the ground. The organizations providing aid to breastfed and formula-fed infants in Haiti include: UNICEF, Save the Children, Action Against Hunger and World Vision.

ILCA has several free downloadable resources for families, health care providers, and relief workers in English, Spanish, and French. The website also has a user-friendly “Find a Lactation Consultant Directory” of available International Board Certified Lactation Consultants (IBCLCs) worldwide who can assist new mothers or relief workers with lactation.

Jim Smith, Executive Director International Lactation Consultant Association 919-861-5577
Weekend/Evening Requests:Cathy Carothers,
ILCA Press Room

Categories: crisis, health, Science

Tags: , , ,

7 replies

  1. Elisabeth Marie Alice Victoria, in past times (and I’m not sure in which countries exactly) rich (white) women would pay poor women (usually women of colour) to nurse their children, often depriving the poorer women’s children of breastmilk.
    I just wanted to say that I found the term “cross-nursing” very obvious in it’s meaning – I think it’s a great term to use. Shared breastfeeding I don’t like the term as much.

  2. (Pay no attention to the morphing troll behind the curtain…)
    Katherine: “Shared breastfeeding” is a useful term where “nursing” doesn’t mean “breastfeeding”. In Australia, for example, and I think possibly Britain, “nursing” a baby is just holding the baby on your lap or in your arms. “Cross nursing” might be … doing so while irritated?
    I’m not sure what the appropriate term would be in Haitian French, but starting at a descriptive term like “shared breastfeeding” is probably a more useful way for translators to find out.

  3. I have to admit, “cross nursing” got me – I’ve lived in the US a long time, but “cross” still means “irritated”. 🙂
    But both work. I was incredibly angry at the negative reaction in the US at Selma Hayek’s breast-feeding, because it was such a generous and loving thing to do. People are weirdly squeamish about breasts and milk, and it drives me up the wall – especially since the concept of formula took hold in the US because male doctors promoted it as “cleaner” than nasty, icky women’s milk.

  4. I appreciate the informative posts you’ve been making on Haiti. I have a question you might know the answer to: are any aid groups distributing formula, and if so, which ones? I would like to share the info with the co-op preschool I volunteer in and the elementary schools I visit – to warn them off organizations that provide formula. Thanks!

  5. I thought breastfeeding organizations were urging donations of breastmilk because of the Haiti earthquake? Although the donations were going to US babies and milk banks in the USA–except for the few infants on the US Comfort, naval ship. Interesting how news stories or is that public relation campaigns shift and change like the tides in the ocean.

  6. I have a question you might know the answer to: are any aid groups distributing formula, and if so, which ones?

    Yes, lots are. It’s pretty much impossible to list them. Best for people to either make their own enquiries, or stick to the ones listed at the Emergency Nutrition Network site. Note that those ENN groups _do_ provide formula, when and if it is needed, in safer and supported ways. As opposed to just dumping it on the population.
    Valerie: There was an intial call for breastmilk donations, until people realised/got the word out that it’s not a particularly useful or sustainable action. Internation breastmilk donations never have been; they’re feel-goody, but on closer examination are very obviously poor value for money and impractical in terms of disaster aid. I expect the “IBMP” has done far more good for Prolacta’s profits than for infants in need.

  7. IBMP partnered with HMBANA for this media blitz about breastmilk donations that was “called off.” Does anyone know if this is a one-time shot or will this be a more permanent partnership?

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